- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,606.93 / $18,197.01
| Facility | | $2,511.89 | $6,606.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,489.63
| Facility | | $3,630.78 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $2,511.89 / $7,762.47
| Facility | | $66.07 | $2,511.89 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $229.09 / $645.65
| Professional | | $151.36 | $229.09 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $512.86 / $831.76
| Professional | | $389.05 | $512.86 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $28,840.32
| Facility | | $5,248.07 | $5,248.07 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $524.81 / $812.83
| Facility | | $389.05 | $524.81 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,413.10 / $15,135.61
| Facility | | $3,801.89 | $7,413.10 | $15,135.61 |